Disease burden and related risk factors of esophageal cancer in China and globally from 1990 to 2021, with forecast to 2035: An analysis and comparison

Abstract

Introduction: In this study we estimate the burden of esophageal cancer (EC) in China and globally from 1990 to 2021, with a forecast to 2035, using Global Burden of Disease (GBD) data. We also analyze the related risk factors to investigate burden trends.

Methods: Mortality, disability-adjusted life years (DALYs), crude rates, and age-standardized rates of EC were analyzed in China and globally from 1990 to 2035, utilizing GBD open data as a secondary dataset analysis of GBD data. Temporal change trends of EC risk factors were analyzed from 1990 to 2021. Joinpoint regression determined average annual percentage change (AAPC) of age-standardized rates. Descriptive analysis compared mortality and DALYs by age groups. Bayesian age-period-cohort (BAPC) predicted age-standardized mortality and DALYs rates for the next 14 years.

Results: The ASMR and ASDR fluctuations in EC were significant in China, showing an overall downward trend. Globally, although there was also a downward trend, the fluctuations were relatively mild. The number of deaths and DALYs related to EC in China and globally showed a significant upward trend. Age-specific burden trends in China for EC indicated that the age group with the peak number of EC deaths shifted to the 70-74 years age group in 2021, while DALYs peaked in the 65-69 years age group. The crude mortality rate (CMR) peaked consistently in 1990 and 2021, both within the 90-94 years age range, while the crude DALY rate (CDR) shifted to the 85-89 years age group. Overall, the burden of EC deaths and DALYs in the population aged <40 years was relatively low, increasing rapidly after the age of 40 years, reaching a peak and gradually declining, and reaching a lower level after the age of 85 years. The predictive results of the BAPC model indicated that over the next 14 years, both ASMR and ASDR for EC in China and globally would show a slight overall increase. The GBD 2021 study identified smoking, high alcohol use, chewing tobacco, and diet low in vegetables as the main risk factors affecting EC mortality rate and DALYs. Among these, smoking and alcohol use were the most significant risk factors, with a higher impact on EC in China compared to the global level. From 1990 to 2021, the overall changes in ASMR and ASDR indicate a decreasing trend in the impact of these four risk factors on EC mortality rate and DALYs.

Conclusions: The burden of EC is expected to steadily increase in China and globally until 2035, posing a significant challenge. Targeted prevention and control policies, such as calling on people to quit smoking and reduce alcohol use, may help curb this upward trend.

Keywords: DALYs; esophageal cancer; mortality rate; trend.

Figure 1

A) Trends in the number of deaths and ASMR for EC in China and globally from 1990 to 2021; B) Trends in the number of DALYs and ASDR for EC in China and globally from 1990 to 2021. The bar graphs represent the quantity, while the line graphs represent the age-standardized rates (ASR)

Figure 2

A) Joinpoint regression analysis of ASMR for EC in China and globally from 1990 to 2021; B) Joinpoint regression analysis of ASDR for EC in China and globally from 1990 to 2021

Figure 3

A) Number of deaths and crude mortality rate (CMR) for EC in different age groups in China and globally in 1990 and 2021; B) Number of DALYs and crude DALYs rate (CDR) for EC in different age groups in China and globally in 1990 and 2021. The bar graphs represent the quantity, while the line graphs represent the crude rates (CR)

Figure 4

A) Forecasted number of deaths and ASMR for EC in China and globally over the next 15 years; B) Forecasted number of DALYs and ASDR for EC in China and globally over the next 15 years. The bar graphs represent the quantity, while the line graphs represent ASR

Figure 5

Detailed ranking of the main risk factors attributing to ASMR for EC in China and globally from 1990 to 2021. A) Global; B) China. Dashed lines indicate an increase in rank. Solid lines indicate a decrease in rank or no change. Data in parentheses represent the 95% uncertainty interval

Figure 6

Detailed ranking of the main risk factors attributing to ASDR for EC in China and globally from 1990 to 2021. A) Global. B) China. Dashed lines indicate an increase in rank. Solid lines indicate a decrease in rank or no change. Data in parentheses represent the 95% uncertainty interval